Municipal health care service

Municipal Health Care Services: Include services such as general practitioners, physiotherapists, psychologists, maternity and postnatal care, health centers and school health services, and other preventive health work. The term 'municipal health care’ is often used interchangeably with primary health care and is the part of the healthcare system responsible for providing services where people live and work. It also facilitates and coordinates the services that patients need, from other parts of the healthcare system.

Municipal health care and care services: The services municipalities are responsible for according to the Act relating to the municipal health services (Lov om kommunale helse- og omsorgstjenester m.m). It includes health promotion and preventive health care, diagnosis and treatment, habilitation/rehabilitation, as well as health and care services in institutions or at home. In Statistics Norway (SSB), the statistics 'Municipal Health Care Services' and ‘Care Services' together constitute the municipal health care and care services. You can find statistics for the care services here.

Municipal health care services and care services are closely related, and some variables presented under municipal health care services apply to the entire municipal health care and care services. For example, this applies to statistics on man-years of ergo therapists and psychologists.

KOSTRA – functions: The functions in KOSTRA aim to capture specific activities or services in the municipality, regardless of how the municipality has organized this work. The following functions make up the chart of accounts for KOSTRA for expenses related to the municipal health and care services:

• 241 Diagnosis, treatment and rehabilitation
• 232 Prevention health care, school/health centers
• 233 Preventive health care
• 234 Activation of elderly and disabled
• 253 Nursing and care services in institutions
• 254 Nursing and care services home-based
• 256 Emergency health and care services

Functions 234, 253, 254, and 256 are included in the accounts of the care services. For statistics on man-years, overarching administration of health and care services, function 120 Administration, is also included.

Man-years: Man-years= Position percentage/100. For example, a 50 percent position is counted as half a man-year. Only agreed-upon working hours should be recorded, and overtime should not be included. This means that it's the contractual hours, not the actual hours worked, that are recorded. The registration covers contractual hours for personnel during a representative week at the end of the year. The number of hours per week is then converted into man-years by dividing by a standard number of hours per week. In practice, this means dividing by 36 hours for physiotherapists and 37.5 hours for physicians. Man-years for physicians and physiotherapists in municipal health and care services are reported in KOSTRA form 1. For other professional groups within municipal health and care services, man-years are obtained from a registry. Employees are registered based on their education as of December 31 of the year before the reference year.

Register-Based Employment Statistics: The data source for the register-based employment statistics is the "a-ordning". The a-ordning is a coordinated reporting of wage and employment information to the Norwegian Tax Administration (Skatteetaten), the Norwegian Labour and Welfare Administration (NAV), and Statistics Norway (Statistisk sentralbyrå), regulated by the A-information Act (A-opplysningsloven). You can read more about this under "Data Sources" and "Collection of Data." Statistics on psychologists, ergo therapists, and personnel in health centers and school health services are derived from Statistics Norway's register-based employment statistics.

Man-year figures at the municipal level do not account for potential purchases and sales across municipal borders. They also do not consider intermunicipal cooperation. If municipalities have intermunicipal cooperation for various personnel, the man-years will only be registered in the host municipality.

Agreement Type/wage agreements: By agreement type, we mean the form of affiliation that each individual physician and physiotherapist has with the municipality. A physician or physiotherapist can have an agreement/a contract with the municipality as a private practitioner, can be employed by the municipality with a regular pay, or be employed as a mandatory practitioner (LIS1 for physicians). For physicians, there is also an additional category in the statistics; physicians without an agreement. Starting from the 2021 dataset, only municipally financed hours for physicians without agreements are counted in the statistics. For previous datasets, man-years for private physicians without agreement, and not municipally financed, were also included. For the 2020 dataset, data for physicians without agreements was not reported.

Private physicians with agreements: Private practitioners who have an agreement with a municipality to be part of the general practitioner scheme. These practitioners are essentially self-employed but enter into agreements with the municipality or district to practice as a general practitioner, with responsibility for a specified number of residents. In addition, the agreements may require physicians to participate in on-call services and other municipal tasks such as care services and health centers. The extent to which each physician is required to perform these tasks, as well as the opening hours for their practices, is defined in the specific agreements between the physician and the municipality/district. The income for physician and physiotherapists with municipal agreements is based on reimbursements from the National Insurance Scheme, patient co-payments, and a fixed amount (operating subsidy) from the municipality. This arrangement is based on an agreement between the The Norwegian Association of Local and Regional Authorities (KS), the Ministry of Health and Care Services, and the physicians' organizations.

Municipal employed physicians: physicians employed as either municipal chief medical officers, physicians with regular pay agreements in a general practitioner position, or physicians with responsibilities for medical work in the municipal health care services, such as in health centers and/or school health services, possibly a combination of these.

Mandatory practitioner (LIS1): A physician who has begun specialist training and is employed in an educational position in municipal health and care services during the first part of their training.

Physicians without Agreements: Private physicians without a general practitioner agreement or employment with the municipality. In this statistics, only municipally financed hours should be reported for physicians without agreements. Hours worked by private physicians that are not municipally financed should be excluded from reporting. Until the 2019 dataset, wholly private physicians without agreements, not financed by municipalities, were included in man-year figures.

Regular General Practitioner: A physician who enters into an agreement with a municipality to participate in the general practitioner scheme, regardless of whether the doctor is employed by the municipality or is a private practitioner. According to the regulation on the general practitioner scheme in municipalities, the GP should cover all general practitioner tasks for the individuals on its patient list.

In the statistical tables related to general practitioners, under the heading 'Regular general practitioners' on the statistics page, the unit is individuals with agreements with municipalities to practice as general practitioners, not the number of agreements or full-time equivalents. Each general practitioner is counted only once. In cases where the general practitioner has agreements with multiple municipalities, the municipality with the longest patient list is chosen as the main practice municipality. If the general practitioner has an equally long list in multiple municipalities, the municipality where the agreement extends furthest into the future is chosen. The source of this data is from Fastlegeregisteret (General practitioner register). Data from Fastlegeregisteret is also part of the KOSTRA municipal health care services statistics: General Practitioner Lists and General Practitioner Consultations. Here, the statistical unit is general practitioner agreements.

Patient List Status: The variable is calculated as the ratio between the general practitioner's list capacity (established in the agreement with the practice municipality) and the number of residents (patients) on the list. A list is considered open (available spots) if the list capacity is more than 20 greater than the actual number of residents on the list. A list is considered closed (no available spots) if there are fewer than 20 available spots on the list.

Physiotherapists with Municipal Contracts: These individuals are typically private practicing physiotherapists but enter into agreements with the municipality or district. The income basis for physiotherapists with a municipal agreement includes reimbursements from the National Insurance Scheme, patient co-payments, and a fixed amount (operating grant) from the municipality as compensation for the agreement. This arrangement is based on an agreement between the Association of Norwegian Municipalities (KS), the Ministry of Health, and the organizations of physiotherapists. The municipality defines the need for and establishes the dimensioning of the physiotherapy service in its municipality, and the operating agreements may be of various sizes. Since 2013, operating agreements with less than 50 percent of full funding are not permitted.

Under municipal health care services statistics, you can also find figures on physiotherapists with municipal operating agreements from the KUHR-register (Control and Payment of Health Reimbursements).

Physiotherapist with regular pay: A physiotherapist who is employed by and receives salary from the municipality., covers full-time and part-time positions. The tasks of physiotherapists are defined through municipal instructions.

Mandatory practitioners - Physiotherapist: An individual who has completed physiotherapy education and is in rotational service, where 6 months are to be completed in municipal health and care services and 6 months in specialized health services. This form of rotational service is a requirement for obtaining authorization as a physiotherapist.

Midwife: A publicly approved nurse with a two-year specialization in care during pregnancy, midwifery, and women's health. In this statistic, you will find figures for contractual man-years for midwives working within the health centers and school health service. The contractual man-years within industry/NACE 86.903, which covers health centers and school health services in the Register based employment statistics, are counted for all individuals registered with midwife education in the education register. Man-years are counted in the municipality where they are employed, even if parts of the man-years are allocated to serve residents in other municipalities.

Ergotherapist: Professionally educated healthcare personnel who practice ergotherapy. Central to the work of ergotherapists is the targeted use of activity to promote mastery, meaning, and health. In this statistic, you will find figures for contractual man-years for ergotherapists. These include contractual man-years for all individuals registered with ergotherapy education who are employed within the municipal health and care services (municipal health care services + municipal care services), including both municipal and private practicing man-years. in the statistics man-years appear in the municipality where they are employed, even if parts of the man-years are allocated to serve residents in other municipalities. Private practicing man-years appear in the municipality where the business is registered.

Psychologist in the Municipal Health Care and Care Services: An individual who has completed a professional psychology degree and has obtained public-approved authorization. In this statistic, you will find figures for contractual man-years for psychologists employed within the municipal health and care services (municipal health services + municipal care services). In the statistics man-years appear in the municipality where they are employed, even if parts of the man-years are allocated to serve residents in other municipalities.

Activity in the Health Centers and School Health Service: The services provided by the health centers and school health services include various consultations/examinations. In this statistic, you will find figures for newly registered pregnant women, home visits by midwives within three days after returning home from the maternity ward, home visits by public health nurses for newborns, examinations at 8 weeks, 2 years of age and 4 years of age, and at 1st grade of primary school.

Healthy Life Center: The Healthy Life Center is a health-promoting and preventive health service. The target group includes individuals with illnesses, or an increased risk of illness, who need support to change their lifestyles and manage health challenges.

Number of Municipalities and Counties

The number of municipalities and counties has changed over time. There were some bigger changes in the start of 2020 and 2024. As of 2020, there were 357 municipalities and 11 counties, and as of 2024 there are 358 municipalities and 15 counties. You can find the current and older municipal divisions in the Classification of municipalities here and the current and older county divisions in the Classification of county here.

Municipal Groups

To better compare data between municipalities, Statistics Norway (SSB) have categorized municipalities based on population and economic frameworks since the 1990s. As a result of the municipal reform that took effect from January 1, 2020, a revision of the municipal groups used in KOSTRA for the publication of 2020 data was done. You can read more about the new and older KOSTRA groups here (ssb.no). An overview of the categories is available in Excel format on this webpage. The code list for KOSTRA municipalities is available here (ssb.no)

Classification of Municipal Centrality

The classification of how central different municipalities are is based on the classification of centrality (ssb.no). In the latest version from 2020, there are 6 codes for centrality, ranging from 01 (high) to 06 (low). In the previous standard applicable from 2008 to 2019, the categories were: Central municipalities, somewhat central municipalities, less central municipalities, and least central municipalities.

Statistics on General Practitioners (GPs) by Immigration Category

For the statistics on General Practitioners (GPs), Classification of immigration categories (from 2008) (ssb.no) is used. This standard has 6 categories, but in the statistics, only the code for immigrants (B) is used, while the other categories (A, C, E, F, G) are combined as "Regular GPs, other." General practitioners who are not resident in Norway are included as "Regular GPs, immigrants."

The grouping of general practitioners who are immigrants by country of birth follows the Classification of country codes (ssb.no). In the statistics table, countries of birth are grouped as follows: 1) Nordic countries (except Norway) 2) EU/EFTA/UK (except the Nordic countries) 3) Europe except EU/EFTA/UK 4) Asia, Africa, Latin America, Oceania excluding Australia and New Zealand 5) USA, Canada, Australia, and New Zealand.